Healthcare Provider Details

I. General information

NPI: 1356935514
Provider Name (Legal Business Name): SCOTT BAREFOOT HAS BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 14TH ST W
BRADENTON FL
34207-1429
US

IV. Provider business mailing address

4509 14TH ST W
BRADENTON FL
34207-1429
US

V. Phone/Fax

Practice location:
  • Phone: 941-752-3300
  • Fax: 941-752-3302
Mailing address:
  • Phone: 941-752-3300
  • Fax: 941-752-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: